Catheter Fracture Research Articles

Analysis of the reason and handling measures of catheter fracture of the implantable vascular access device

Objective To analyze the reasons of catheter fracture of implantable vascular access devices and to explore the prevention and handling measures. Methods A retrospective analysis was carried in 3 887 adult patients with implantable vascular access devices and 13 had catheter fracture. The clinical features and causes were analyzed and the successful handling measures were summarized. Results Of 3 887 cases, a total of 13 (0.33%) catheter fracture occurred. The incidence rate of catheter fracture via subclavian jugular venipuncture was 3.70%,(6/162) , via internal jugular venipuncture was 0.18% (7/3 725), via internal jugular venipuncture was significantly lower than that via the subclavian venipuncture (χ2=47.505, P=0.000). There had no statistical differences between the left and right of the two puncture ways (P=0.707, 0.682). Conclusions Catheter fracture is one of the serious complications in the process of use and maintenance of implantable vascular access device. Choosing appropriate surgical method, strengthen maintenance education, specificating the operation procedure, closing observation and other measures can not only reduce the occurrence of the catheter fracture, but also can dealt with catheter fracture in time, which could ensure the safety of patients' life. Key words: Implantable vascular access device; Catheter fracture

IVC filter retrieval in adolescents: experience in a tertiary pediatric center.

Inferior vena cava (IVC) filters are commonly implanted with the intent to prevent life-threatening pulmonary embolism in at-risk patients with contraindications to anticoagulation. Various studies have reported increases in the rate of venous thromboembolism within the pediatric population. The utility and safety of IVC filters in children has not yet been fully defined. To describe the technique and adjunctive maneuvers of IVC filter removal in children, demonstrate its technical success and identify complications. A retrospective 10-year review was performed of 20 children (13 male, 7 female), mean age: 15.1 years (range: 12-19 years), who underwent IVC filter retrieval. Eleven of 20 (55%) were placed in our institution. Electronic medical records were reviewed for filter characteristics, retrieval technique, technical success and complications. The technical success rate was 100%. Placement indications included: deep venous thrombosis with a contraindication to anticoagulation (10/20, 50%), free-floating thrombus (4/20, 20%), post-trauma pulmonary embolism prophylaxis (3/20, 15%) and pre-thrombolysis pulmonary patient (1/20, 5%). The mean implantation period was 63 days (range: 20-270 days). Standard retrieval was performed in 17/20 patients (85%). Adjunctive techniques were performed in 3/20 patients (15%) and included the double-snare technique, balloon assistance and endobronchial forceps retrieval. Median procedure time was 60 min (range: 45-240 min). Pre-retrieval cavogram demonstrated filter tilt in 5/20 patients (25%) with a mean angle of 17° (range: 8-40). Pre-retrieval CT demonstrated strut wall penetration and tip embedment in one patient each. There were two procedure-related complications: IVC mural dissection noted on venography in one patient and snare catheter fracture requiring retrieval in one patient. There were no early or late complications. In children, IVC filter retrieval can be performed safely but may be challenging, especially in cases of filter tilt or embedding. Adjunctive techniques may increase filter retrieval rates.

Iatrogenic complications: a line's share

Encountering foreign bodies in clinical practice is not uncommon. More so are intra-vascular foreign bodies. Foreign bodies encountered vary in different scenarios depending on the person; children, elderly or mentally retarded or the cause; iatrogenic as in our case. In clinical practice vascular foreign bodies are the most commonly encountered iatrogenic foreign bodies. Fracture of intravenous catheter is one of those iatrogenic vascular foreign bodies. Here we describe a case report on a vascular foreign body due to fracture of intravenous cannula in the cephalic vein and which has migrated proximally.

A Novel Two-Step Technique for Retrieving Fractured Peripherally Inserted Central Catheter Segments Migrating into the Heart or the Pulmonary Artery.

Objective. To report the experience of a percutaneous technique for retrieving fractured peripherally inserted central catheter (PICC) segments migrating into the heart or the pulmonary artery. Method. From April 2013 to July 2015, we performed percutaneous retrieval of fractured PICC segments migrating into the heart or the pulmonary artery in five cancer patients who had undergone chemotherapy via PICC. The fractures were diagnosed with chest plain radiography. The patients included three cases of breast cancer, one case of rectal cancer, and one case of lower limb Ewing's tumor. The fractures were retained in the vessels of the patients for 1 to 3 days. All the fractures were retrieved by using a novel two-step technique in the digital subtraction angiography (DSA) suite. This two-step technique involves inserting a pigtail catheter to the heart or the pulmonary artery to grasp the fractured catheter fragment and bring it to the lower segment of the inferior vena cava, followed by grasping and removing the catheter fragment with a retrieval loop system of the vena cava filter retrieval set. Result. The fractured PICC segments were removed successfully in all five patients via unilateral (four patients) or bilateral (one patient) femoral vein access. No complications occurred during the interventional procedure. Conclusion. Percutaneous retrieval can be a safe, convenient, and minimally invasive method for the removal of fractured PICC segments. The technique reported in this paper will be applicable for the retrieval of fractured PICC segments and other catheter fragments migrating into the heart or the pulmonary artery.

Cross-sectional imaging of thoracic and abdominal complications of cerebrospinal fluid shunt catheters.

This study aims to review the imaging findings of distal (thoracic and abdominal) complications related to ventriculo-peritoneal (VP), ventriculo-pleural (VPL), and ventriculo-atrial (VA) cerebrospinal fluid (CSF) shunt catheter placement. Institution review board-approved single-center study of patients with thoracic and abdominal CSF catheter-related complications on cross-sectional imaging examinations over a 14-year period was performed. Clinical presentation, patient demographics, prior medical history, and subsequent surgical treatment were recorded. The presence or absence of CSF catheter-related infection and/or acute hydrocephalus on cross-sectional imaging was also recorded. There were 81 distal CSF catheter-related complications identified on 47 thoracic or abdominal imaging examinations in 30 patients (age 5-80 years, mean 39.3 years), most often on CT (CT = 42, MRI = 1, US = 4). Complications included 38 intraperitoneal and 11 extraperitoneal fluid collections. Extraperitoneal collections included nine abdominal wall subcutaneous (SC) pseudocysts associated with shunt migration and obesity, an intrapleural pseudocyst, and a breast pseudocyst. There were also two large VPL-related pleural effusions, a fractured catheter in the SC tissues, and a large VA shunt thrombus within the right atrium. Ten patients (33.3 %) had culture-positive infection from CSF or shunt catheter samples. Ten patients (33.3 %) had features of temporally related acute or worsening hydrocephalus on neuroimaging. In four of these patients, the detection of thoracic and abdominal complications on CT preceded and predicted the findings of acute hydrocephalus on cranial imaging. Thoracic and abdominal complications of CSF shunts, as can be identified on CT, include shunt infection and/or obstruction, may be both multiple and recurrent, and may be predictive of concurrent acute intracranial problems.

Long-term venous access insertion: 'the learning curve'.

The central venous access port device (CVAPD) provides reliable vascular access and is used for delivery of fluids and for obtaining blood samples. However, it can carry some intra- and post-operative complications such as thrombosis, pneumothorax, catheter fracture and port malposition. This article describes one surgeon's experience over a 16-year period and strategies to avoid complications. The data were prospectively collected from 1996 to 2012 (16-year period). Collected data included age and gender of the patient, pathology, type of port used, anaesthetic type, side and site of insertion, and complications. A total of 958 devices were implanted. The average age of the patient was 57.8 years. Sixty-eight complications were recorded with an average complication rate of 7.1%. This rate decreased from 23% between 1996 and 1997 to 3.6% from 2010 to 2013. Venous thrombosis was the main source of complications with an incidence of 2.5%. This complication occurred in seven of the first 86 patients (8.1%, 1996-1998) and decreased to 1.9% between 2000 and 2013. Twenty infections (2%), five pneumothoraces secondary to insertion (0.5%), one port malposition (0.1%) and three fractures of the catheter (0.3%) occurred over the 16 years. The surgeon's complications of CVAPD insertion requiring removal or revision of the port were considerably reduced as the surgeon's experience increases. It is suggested that all surgeons whose practice includes CVAPD insertion will have an initial learning curve, and strategies described in this paper may help decrease the number of complications.

Ampullary Carcinoma Associated With Removing Fractured Percutaneous Transhepatic Biliary Drainage Catheter for Hilar Cholangiocarcinoma

Percutaneous transhepatic biliary drainage (PTBD) is an established method for decompression of biliary tract. Many complications related to PTBD have already been reported, however, spontaneous and complete fracture of PTBD catheter just after procedure is considered to be quite rare. We encountered a case, which PTBD catheter completely fractured on the next day of insertion for biliary obstuction due to hilar cholangiocarcinoma and advanced ampullary carcinoma was appeared at only ten months after removal of the fractured PTBD catheter. A 73-year-old man was diagnosed as hilar cholangiocarcinoma and PTBD was performed. PTBD catheter completely fractured on the next day of insertion. When the fractured PTBD catheter was endoscopically removed though papilla of Vater, there was no abnormality in both papilla of Vater and lower bile duct. Endoscopic biliary drainage was simultaneously performed. Consequently, he underwent extended right hepatectomy with resection of extrahepatic bile duct for Bismuth type IV hilar cholangiocarcinoma. Pathological examination of the resected specimen demonstrated that the tumor mainly composed of moderately differentiated adenocarcinoma and directly invaded to the hepatic parenchyma of the right lobe of the liver; therefore, the tumor was finally diagnosed to be stage IIA (pT3pN0M0) according to TNM classification. The distal stump of bile duct, which was transected at upper border of the pancreas, was pathologically confirmed to be free of cancer. At eight months after surgery, ampullary cacinoma was presented in the follow-up examination.Subtotal stomach-preserving pancreaticoduodenectomy was performed. Because pathological investigation revealed that the tumor was 4-cm in diameter and involved to both pancreas and duodenum, it was diagnosed as stage IIB (pT3pN1M0) according to TNM classification. The postoperative course was uneventful, however, he died of recurrence of ampullary carcinoma at fifteen months after the second operation in another hospital and an autopsy was not performed. We experienced a rare complication that was spontaneous and complete fracture of PTBD catheter on the next day of insertion. When the fractured PTBD catheter was removed by endoscopically, there were no abnormal findings in papilla of Vater and lower bile duct. Therefore, it was presumed that ampullary carcinoma was strongly associated with the removal of the fractured catheter through papilla of Vater. Endoscopic biliary drainage is recommended for decompression of malignant biliary obstruction.

Physical characteristics of catheters used for subarachnoid drainage

BackgroundCerebrospinal fluid diversion through lumbar drainage catheters is a routine procedure that is used in a variety of clinical applications. Fracture of catheters during insertion or removal may result in...

A peripherally inserted central vein catheter fractured and slid into the right pulmonary artery: A case report

Abstract Catheter fracture is a rare but serious complication of a peripherally inserted central catheter (PICC). An adolescent patient was sent to Tianjin Medical University General Hospital (Tianjin, China) because the PICC was fractured when removed by a nurse. Chest X-ray showed that the PICC fragment slid into the right pulmonary artery. Through emergency surgery, the remainder of the PICC was successfully retrieved by an interventional operation percutaneously via the right femoral vein. PICC fracture is less common and always without significant discomfort if not found timely, and it may lead to serious complications, such as pulmonary embolism, and even death. Thus, nurses, patients and their family members should pay enough attention to the daily maintenance of PICC and have a deep understanding of the reasons associated with PICC fracture as well as how to prevent it. Interventional operation is minimally invasive, which is a good choice for the removal of intravascular foreign bodies, leading to fewer complications and a good prognosis.

Clinical application research of implantable venous-access port with different surgery approaches

Objective To compare of the clinical using effect of implantable venous-access port(VAP)among different methods and the postoperative complication. Methods From 2011 to 2014,a total of 359 patients with VAP were included in this study.All patients were divided into two groups according to the surgery approaches methods, 307 cases were implanted through internal jugular vein,and other 52 cases were through subclavian vein intubation. Statistics of postoperative flow conditions and complication between the two groups were gathered and compared. Results There were 3 cases of postoperative infected,and 13 cases were not free of transfusion,while 2 cases catheter were shed and shifted in the 307 cases of implantation through internal jugular vein,the complication rate was 5.86%; In other group,which in total of 52 cases of implantation through subclavian vein,including 2 cases were postoperative infected,6 cases were not free of transfusion,2 cases are of catheter fracture and5 cases were local hematoma,the complication rate was 28.85%.There was difference in rate of catheter leakage,catheter tip dystopy and catheter related infection between two groups[the proportion of through internal jugular vein vs that the group through subclavian vein: 5.86%(18/307)vs 28.85%(15/52),χ2=28.140,P=0.000]. Conclusion The study suggests that the two ways of different operation methods of VAP are safe and reliable for long term intermittent venous access.The internal jugular vein implanted group has a slight advantage over the group of subclavian vein implanted,when it comes to develop the patients'living quality. Key words: Implantable Venous Access port; Subclavian Vein; Internal Jugular Vein

A Novel Technique for Distal Shunt Revision: Retrospective Analysis of Guidewire-Assisted Distal Catheter Replacement.

Ventriculoperitoneal shunt revision is a common procedure. Disconnection and fracture of the distal catheter remain a common cause of ventriculoperitoneal shunt malfunction. To describe a novel procedure for peritoneal replacement of the distal catheter by using a guidewire and a modified Seldinger technique (guidewire-assisted distal catheter replacement) and retrospectively evaluate the results of the surgical procedure. Between September 2005 and December 2013, 68 patients were treated by a single surgeon (DMW) with distal catheter replacement using our technique. In brief, the previously placed distal catheter was exposed at its entry site into the abdomen. A soft guidewire with hydrophilic coating was inserted down the distal catheter into the peritoneum. The distal catheter was then removed over the guidewire, leaving the guidewire in place. A peel-away sheath and dilator were then inserted over the guidewire, and the dilator and guidewire were removed. The new distal catheter was then passed from the valve to the abdomen and was then fed through the peel-away sheath into the peritoneum. Charts were retrospectively reviewed for preoperative presentation, operative technique, and postoperative outcome. Records were specifically examined for any early or late complications. The mean patient age at surgery was 13 years. No immediate acute complications were noted. Of the 68 total patients, 45 patients had more than 6 months of follow-up. Of the 68 patients, 7 patients required another distal revision after guidewire-assisted distal catheter replacement. Distal shunt malfunction due to a mechanical failure is a common reason for shunt revision. We describe a technique for guidewire-assisted distal catheter replacement.

Bilateral Venous Femoral Catheter Fracture and Migration: Case Report and Review of Literature

In developing countries like ours, patients with End Stage Renal Disease present late requiring urgent haemodialysis. The femoral vein is commonly used in this situation, as access is easier and faster with few complications. Few cases of catheter fracture and migration have been reported. We aim at reporting a case of 26-year-old woman who presented with bilateral venous femoral catheters fracture and migration. Both were successfully removed via bilateral groin exploration and venotomy. We recommend early removal in order to avert life-threatening complications.

A Retrospective Analysis of Ventriculoperitoneal Shunt Revision Cases of a Single Institute.

ObjectiveVentriculoperitoneal (VP) shunt complication is a major obstacle in the management of hydrocephalus. To study the differences of VP shunt complications between children and adults, we analyzed shunt revision surgery performed at our hospital during the past 10 years.MethodsPatients who had undergone shunt revision surgery from January 2001 to December 2010 were evaluated retrospectively by chart review about age distribution, etiology of hydrocephalus, and causes of revision. Patients were grouped into below and above 20 years old.ResultsAmong 528 cases of VP shunt surgery performed in our hospital over 10 years, 146 (27.7%) were revision surgery. Infection and obstruction were the most common causes of revision. Fifty-one patients were operated on within 1 month after original VP shunt surgery. Thirty-six of 46 infection cases were operated before 6 months after the initial VP shunt. Incidence of shunt catheter fracture was higher in younger patients compared to older. Two of 8 fractured catheters in the younger group were due to calcification and degradation of shunt catheters with fibrous adhesion to surrounding tissue.ConclusionThe complications of VP shunts were different between children and adults. The incidence of shunt catheter fracture was higher in younger patients. Degradation of shunt catheter associated with surrounding tissue calcification could be one of the reasons of the difference in facture rates.

Reasons analysis and countermeasures for neonatal PICC abnormal extubation

Objective To explore the reasons and countermeasures for neonatal PICC abnormal extubation. Methods Retrospective research method was used to count and analyze the risk factors of eighty six cases with neonatal PICC abnormal extubation. Results Among clinical research participates, there were thirteen cases of abnormal tube drawing, accounted for 15.12% (13/86), among which ectopic catheter accounted for 46.15% (6/13), tube plugging 15.38%(2/13), Catheter Related Blood Stream Infection(CRBSI) 15.38%(2/13), phlebitis 7.69%(1/13), catheter prolapse 7.69% (1/13) and catheter fracture 7.69% (1/13). Conclusions The main reasons of neonatal PICC abnormal exbutation are catheter ectopia and indwelling complications. Therefore, clinical nurses should pay more attention to preventing high risks and regulating nursing care for the reduction of abnormal exbutation. Key words: Intensive care units, pediatric; PICC; Abnormal exbutation

Increased Spasticity From a Fracture in the Baclofen Catheter Caused by Charcot Spine: Case Report

In patients with Charcot spine, a loss of normal feedback response from the insensate spine results in spinal neuropathy. Increasing deformity, which can manifest as sitting imbalance, crepitus, or increased back pain, can result. We present the case of a patient with a high-thoracic spinal cord injury (SCI) who subsequently developed a Charcot joint at the T10-11 level that resulted in a dramatic increase in previously controlled spasticity after fracture of an existing baclofen catheter. The 68-year-old man with T4 paraplegia presented with increasing baclofen requirements and radiographic evidence of fracture of the intrathecal baclofen catheter with an associated Charcot joint with extensive bony destruction. The neuropathic spinal arthropathy caused mechanical baclofen catheter malfunction and resulting increased spasticity. The patient was found to have transected both his spinal cord and the baclofen catheter. Treatment consisted of removal of the catheter and stabilization with long-segment instrumentation and fusion from T6 to L2. Follow-up radiographs obtained a year and a half after surgery showed no evidence of hardware failure or significant malalignment. The patient has experienced resolution of symptoms and does not require oral or intrathecal baclofen. This is the only reported case of a Charcot spine causing intrathecal catheter fracture, leading to increased spasticity. This noteworthy case suggests that late spinal instability should be considered in the setting of SCI and increased spasticity.

Identification and management of a coronary sinus catheter fracture.

At facilities that offer cardiac surgery services, minimally invasive cardiothoracic surgery is fast becoming commonplace, particularly in aortic, tricuspid, and mitral valve procedures. Use of a coronary sinus catheter, a specialized central venous catheter, to monitor hypothermic depth and provide retrograde cardioplegia has been widely adopted at Tufts Medical Center. Complications of coronary sinus catheter insertion are considered rare but are well documented. In contrast, complications of catheter removal, such as the catheter fracture that we report here, are not well described in the literature. In this case, the catheter tip was retrieved without further patient harm or additional invasive interventions.

Clinical application of totally implantable central venous port

To summarize the disposal methods and the reasons of complications in operation of totally implantable central venous port (TICVP). A total of 2 007 patients were enrolled in this observational, single-center study between December 2008 and March 2013. TICVP implantation was performed with one small skin incision and subcutaneous puncture of subclavian or jugular vein. Patient's profiles, indications of port system, early and delayed complications, and disposal methods were evaluated. There were 38 male and 1 969 female patients, aged from 21 to 85 years, with a mean of 47.6 years. The mean duration of the TICVP system was (242 ± 12) days, ranging from 9 to 1 243 days. The achievement rate of puncture in the right jugular vein (99.76%) was the highest. Sonographic approach using the internal jugular vein were better than the external landmark-guided technique (99.80% vs. 96.34%, χ² = 29.905, P = 0.000). The rate of immediate complication was 0.80%, which included pneumothorax, hemothorax, lymphatic fistula and thrombosis. Early complications rate was 0.10%, which included pocket hematoma, catheter migration, venous thrombosis, port pocket infection, fibrin sheath formation. Late complications rate was 7.87%, which included catheter fracture, pinch-off syndrome, catheter-related bloodstream infection, fibrin sheath formation, catheter migration, extravasation, port inversion and port reveal. The rate of removal due to complications was 1.34% (27/2 007), and the early complication was higher (χ² = 8.053, P = 0.011). The low incidence of complications suggests that TICVP is safe and reliable for long term intermittent venous access. The results support the use of TICVP in the oncology patients and patients requiring long-term intravenous therapy.

Intrathecal baclofen therapy for the symptomatic treatment of hereditary spastic paraplegia

ObjectiveWe study the effectiveness and safety of intrathecal baclofen therapy for the treatment of spasticity and gait improvement in patients suffering from hereditary spastic paraplegia. MethodsSixteen patients diagnosed with hereditary spastic paraplegia (mean age: 43 years) were enrolled in this open prospective study. The main inclusion criteria were: spastic paraparesis with a negative laboratory and imaging work-up (apart from spinal cord atrophy), unsuccessful trial of oral anti-spasticity drugs. An intrathecal baclofen trial was initially performed and a pump for the intrathecal administration of baclofen was implanted to the patients who responded favorably to the baclofen trial. The patients were followed for lower limbs’ spasticity, walking performance and complications. ResultsFourteen patients had a positive baclofen trial and were submitted to the implantation of the baclofen pump. The average follow-up period was 25.8 months. All patients had a reduction in lower limbs’ spasticity measured in the modified Ashworth scale from 2.6 (±0.8) to 0.7 (±0.9) (p=.000). Walking ability was improved in a modified version of the functional walking scale of the Gillette Functional Assessment Questionnaire from 5.9 (±1.7) to 7.4 (±2.0) (p=.001). Two patients had to be re-operated due to a catheter fracture. ConclusionsIntrathecal baclofen can offer an improvement in spasticity and in the walking performance in patients suffering from hereditary spastic paraplegia. The underlying residual motor function and the patient’s adherence to the rehabilitation program might contribute to the post-operative improvement of gait.

241 Totally implantable venous access devices (TIVAD), a survey at the Gothenburg CF-centre

Objective: TIVAD has been used for many years at our CF centre for administration intravenously at home of antibiotics and nutritional solutions. The CF-team give individual information to the patient in need of a TIVAD, which is inserted in local or general anaesthesia. The device is inspected regularly and flushed with normal saline and heparin every one to three months. We avoid to use it for blood samples. We assessed the outcome of TIVADs; reasons for insertion, removal, lasting time and complications. Methods: Demographic and clinical data were extracted from the patient database and patient charts. There were 175 patients [53 (30%) <18 years] with a median age of 23 years (range 0−63) attending the Gothenburg CF-centre during 2013. Lung-transplanted patients (11/175) were excluded from analysis. Results: In total 49 patients (30% of the patient population) − 37 (33%) of the adults and 12 (23%) of the children − had or had previously had a TIVAD and 32 (65%) were females. The total number of TIVADs was 80 (1−5/patient) with a median time lasting of 4.8 (0.1–23.9) years by 31.12.2013. The first TIVAD was inserted at median of 12.5 years of age (range 0.5–38.6) and the major indication was repeated intravenous antibiotic treatments. Reasons for removal/change were infection, occlusion, venous thrombosis, catheter fracture, local trauma or local reaction, patient’s wish or no more need of the device. Three patients with thrombotic complications have new devices and anticoagulant therapy. Conclusion: TIVAD is a good and safe alternative for patients in need of frequent infusions. Complications occur and have to be checked for regularly by the CF nurse.

Training in Placement of Peripherally Inserted Central Catheters in the Neonate

Abstract This is an instructional guide on the placement of a peripherally inserted central catheter (PICC) in an infant. This resource was developed following an iterative review process based on ...